What are the tonsils for?

Tonsils are small glands found at the back of the throat which are part of the lymphatic system, which means their job is to help fight infection. After about the age of three they gradually reduce in size.

Your body can still fight infections even without your tonsils. However if the tonsils are doing more harm than good, then it may be better to have them removed.

Why take them out?

The commonest reason for taking tonsils out is if they cause frequent and recurrent sore throats despite treatment with antibiotics. Another good reason for removing tonsils is if they are so large that they block the airway. Sometimes small children have tonsils and adenoids that are so big that they block their breathing at night, causing loud snoring and pauses in breathing.

Another reason for removing them is following a quinsy, which is an abscess that develops next to the tonsil as a result of a tonsil infection (tonsillitis). It causes a very severe sore throat, restricted mouth opening and inability to swallow. It is generally regarded as being very much more unpleasant than even a severe bout of tonsillitis. Most people who have had a quinsy would therefore usually choose to have a tonsillectomy to prevent having another.

Tonsils are also removed if a tumour is suspected. This may be suspected if there has been a sudden increase in the size of the tonsil or a change in its surface appearance such as ulceration or bleeding. Often tonsillectomy is recommended in people with tonsils that are of different sizes, although in such circumstances tumours are detected extremely rarely.

Do I have to have a tonsillectomy?

It is not always necessary for the tonsils to be removed. You may want to just wait and see if the tonsil problem gets better by itself, particularly if the problem has been recurrent infections and the episodes have not been too frequent. Problems with breathing are often taken more seriously and would require an operation at an earlier stage than perhaps might be the case for infections alone. Your specialist will be able to explain to you whether surgery is the best treatment for you or your child.

Things to know before a tonsillectomy

It would be advisable to arrange two weeks off work or school. This is because there is a risk of acquiring an infection in the immediate postoperative phase. Please also let us know if you have a chest infection or tonsillitis within the week immediately before the admission date – you may require a course of antibiotics although it may still be necessary to postpone the operation if the infection has not cleared in time.

It is also important to tell us if you have had any unusual bleeding or bruising problems, or if this type of problem runs in the family.

Other operations sometimes performed at the same time as tonsillectomy

If there is a history of a blocked nose, snoring or disturbed breathing at night, it is possible that the adenoids may need to be removed as well as the tonsils.

Sometimes there can also be ear problems such as glue ear, which can cause reduced hearing and also speech delay in children. Ion these circumstances, it is possible that grommets may also need to be inserted.

In either of these situations described above, your surgeon will discuss these options with you prior to the tonsillectomy.

How is a tonsillectomy performed?

Tonsillectomy is carried out whilst you are asleep under a general anaesthetic. The tonsils are taken out through the mouth, and then the bleeding is stopped. This takes about 30 minutes. A child or adult who has had a tonsillectomy will then be taken to a recovery area to be watched carefully as he or she wakes up from the anaesthetic.

Different techniques used in tonsillectomy:

  1. Bipolar diathermy: this involves electrical heat generation that dissects tissues and seals off the blood vessels at the same time.
  2. Cold steel: this involves using instruments only to remove the tonsils. It is said to be associated with a reduced risk of infection although bleeding risk in the early period after the operation is a little higher.
  3. Coblation: this involves the use of a radiofrequency wand that coagulates tissues at a lower temperature than bipolar diathermy. There are two ways of using the same wand:
    1. Extracapsular: here the tonsil is removed with the external capsule (which surrounds the tonsil) in the same way as techniques 1 and 2 above
    2. Intracapsular: here the tonsil is vapourised from its outer surface up to (but not including) the capsule. Consequently postoperative pain is generally less severe with intracapsular coblation, however this technique carries a higher chance of some remnant tonsil tissue being left behind.

What can go wrong after a tonsillectomy?

There are some possible risks, side effects and/or complications that can happen after tonsillectomy. These include:

  • Pain/discomfort: The recovery following tonsillectomy always causes discomfort and pain, and this gets worse over the course of the first five to seven days before getting better again. The pain is generally less severe if the coblation intracapsular technique is used.
  • Infection: This occurs in about 1 in 10 patients and can be treated with antibiotics. It is important to make sure that the pain following the surgery does not prevent you from eating as food helps to clear the build up of debris and slough, thereby reducing the risk of a postoperative throat infection.
  • Bleeding: This rarely happens following tonsillectomy surgery. It is more likely if an infection develops, which itself is more likely if patients do not get into a regular habit of eating.
  • Swelling: The soft palate/uvula can get quite swollen after the surgery. This takes about two weeks to settle.
  • Adhesions/scarring: Initially the throat will build up yellow/white debris at the site of the removed tonsils, however after about 10-14 days this will be gradually replaced by scar tissue that is normal.
  • Ear pain: This is due to the nerves in the throat sending a branch to the ear, which can cause referred pain in the ear. Sometimes the earache can be worse than the throat pain.
  • Taste disturbance: It is not unusual to get an alteration in the sense of taste during the recovery period. This can amount to a reduction in being able to detect tastes, or a metallic flavour. In the vast majority of cases this recovers fully. It is highly unusual for any taste disturbance to persist beyond three months.
  • Injury to lips/teeth/gums: The lips will get a little swollen particularly at the corner of the mouth. Dental injury is very unusual although an already wobbly tooth may become more loose during the procedure and may need to be removed to avoid it being knocked into the airway.
  • Recurrent symptoms: Even with successful and complete removal of the tonsils, it is possible to get sore throats in the future such as with a cold or ‘flu. You should however not get an acute attack of tonsillitis.
  • Tonsil regrowth: It is possible for some of the tonsils can regrow after tonsillectomy. The risk of this is around 1% for traditional techniques (diathermy /cold steel) although even if this occurs it does not mean that you will get more problems in the future. It is slightly more likely (risk 3-4%) if the coblation intracapsular technique is used.

Postoperative advice and preparation:

It is advised that you avoid contact with people and dirty/dusty environments for a period of two weeks after the surgery. For most people this means two weeks off work or school (or work from home if your job allows), and avoid crowded places such as restaurants and parties. This is to reduce your risk of getting an infection or virus.

You should also avoid any exercise/gym for two weeks otherwise your blood pressure might go up and increase the risk of bleeding. After two weeks you can resume exercise gently to start with.

Regarding eating, it is best to eat little and often. It is no longer necessary to just eat sharp, crunchy foods although a diet consisting of soft items such as ice cream and mashed potato is also not helpful. A balanced diet of foods that you would normally eat is the best.

Regarding pain relief, please take this regularly and as prescribed. This helps to make your recovery more comfortable and to maintain a good, regular diet.

In most cases a throat spray will be given to you and sometimes antibiotics may also be prescribed.

After a tonsillectomy – what to expect:

It is quite normal for most children to feel a little sick after having the tonsils out. Anti-sickness medicine often needs to be given for this, but it usually settles quickly.

The most obvious thing to expect is a sore throat, which usually lasts for approximately ten days and gets worse before it gets better, reaching a peak at about the 5th – 7th day after the tonsillectomy. It is important to take the prescribed painkillers regularly, half an hour before meals for at least the first week. Aspirin is not safe for children and should never be given to children under 16.

You may have an earache. This is normal – it happens because the same nerves connect your throat and ears. It does not mean that you have an ear problem.

If you look inside your mouth you will notice that the throat looks white – this is the normal appearance while your throat heals. You may also see small threads where your tonsils used to be – they are sometimes used to help stop the bleeding during the operation, and will fall out by themselves.

Some people get a throat infection after surgery, usually if they have not been eating properly. If this happens you may notice a fever and a bad smell from your throat. Call your GP or the hospital for advice if this happens.

Adults and children will need 10 to 14 days off work or school. It is advisable to remain indoors for the first week, keeping away from crowded and smoky places and keeping your distance from people with coughs and colds. You may feel tired for the first few days. After the first week it is OK to gradually increase your activity and get back to normal according to how you feel.

When can I go home after having my tonsils out?

The majority of patients treated by Paul Chatrath go home on the same day as the operation. People do however recover from surgery at different rates and you will only have to stay in hospital overnight if you are taking a little longer to recover or if it is getting very late in the evening. Rest assured that we will only let you go home once you are fully recovered from the immediate effects of the operation, when you are eating and drinking and feel well enough to travel home.

What should I eat after a tonsillectomy?

The most important advice is to eat as close to normally as possible. This helps the throat to heal faster and in fact reduces the discomfort. This in turn reduces the likelihood of a postoperative infection and bleeding. The type of food is not as important as regularity. Small amounts of food more regularly is better than big meals once or twice a day. Try to stick to bland, non-spicy foods where possible. Plenty of fluids is also important, and chewing gum may also help the pain.

The idea is that taking painkillers regularly will allow your child to eat and drink as normally as possible. This will in turn promote healing and reduce pain, infection and bleeding. The converse is also true in that if pain is allowed to increase, food intake suffers and the pain worsens yet further, leading to an infection and possibly bleeding.

Effect on snoring:

Most parents in fact report that their child is so quiet after the surgery that they are just as worried as they were before the surgery when their child was noisy!

Bleeding after a tonsillectomy:

If you notice any bleeding from your throat, you must seek medical advice. If it is only a drop or two, call your GP or the ward of the hospital where you were treated. However, for anything more severe or if in any doubt, it is advisable to go to your nearest hospital casualty department.